Provider Demographics
NPI:1396292397
Name:WEDDLE, GUY THOMAS
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:THOMAS
Last Name:WEDDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 N PAMELA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8490
Mailing Address - Country:US
Mailing Address - Phone:509-992-8070
Mailing Address - Fax:
Practice Address - Street 1:9005 N PAMELA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8490
Practice Address - Country:US
Practice Address - Phone:509-993-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601613891103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst